More than 90 per cent of us will experience headache at some time, making it the most commonly reported symptom, according to NICE. Around one in seven people get migraines, with more than 10 million sufferers in the UK and over a billion worldwide making it the third most common disease, says the Migraine Trust.
“People suspecting migraine should be encouraged to see their GP for a review and diagnosis,” says Ria Bhola, headache nurse specialist at the Migraine Trust. “Obtaining a diagnosis is a crucial first step, which will determine if the person has a primary headache. A neurological assessment will help to eliminate any underlying secondary causes of their symptoms.”
According to Kenny Chan, lead information pharmacist at Numark: “Almost everyone will suffer from headache or migraine at some point, and pharmacists are well equipped to help customers as the first port of call. There are many options for customers to try… it’s really important to assess each patient on an individual basis. Pharmacists should be asking questions about how long they have had a headache or migraine, is it their first one and how severe the pain is.”
The Migraine Trust estimates that 43 million days are lost from work and education each year in the UK because of migraine, while 71 per cent of sufferers say the condition affects their mental health. Migraine is two to three times more common in women – most likely due to hormonal factors as fluctuating oestrogen levels are a known trigger. Around 10 per cent of children get migraines, although the condition generally starts in puberty and peaks around the age of 35-40.
The main symptoms include a throbbing headache (usually on one side) that worsens with movement; nausea, and sensitivity to light and/or sound. There are several stages, and recognising these can help sufferers decide when to take medication that can stop or shorten an attack.
In the ‘premonitory’ or warning stage, people may feel tired and crave certain foods, or experience a stiff neck and mood changes. Around one in four sufferers experience the ‘aura’ stage, which may include visual disturbances, numbness or tingling for between five minutes and an hour.
During the headache stage, patients experience moderate to severe pain made worse by moving around, with many reporting nausea or vomiting.
During the ‘resolution’ stage, the attack slowly fades; sleep usually helps with this. This is followed by the ‘recovery’ stage, during which a ‘hangover’ feeling can linger for hours or days.
What causes migraine?
“Whilst not fully understood, it is known that during a migraine attack, the brain does not process sensory information correctly and this susceptibility is due to a combination of genetic and environmental factors,” says Bhola.
Genetics are an important risk factor, with up to 60 per cent attributable to genes. Common triggers include lack of sleep, changes in the weather, alcohol, stress and excessive sensory stimulation. Foods containing tyramine, nitrates or monosodium glutamate can also act as triggers, as can caffeine.
It’s helpful for customers to keep a migraine diary to help discover their triggers and the warning signs of an attack, recording factors like sleep, daily activities, menstrual cycle and any medications taken.
Treating migraine
During an acute episode, simple analgesics help some sufferers. Opioids should be avoided as they can cause misuse and overuse headache. Anti-emetics are useful for treating nausea and help the body to absorb medication better. These include metoclopramide and domperidone. They should be taken before or alongside analgesics. Combination OTC medication includes paracetamol with caffeine or an anti-emetic.
Triptans reduce pain and nausea. They should be taken at the onset of the headache, and can be taken as tablets, nasal spray, injection or dissolvable tablets.
Customers who get four or more migraines a month should be referred to their GP to discuss preventative medication. Those which a GP can prescribe include angiotensin blockers and ACE inhibitors, anticonvulsants, antidepressants and beta blockers. Calcitonin gene-related peptide antibodies are the first preventive medicines developed for migraine. These have to be prescribed by a specialist and are given as monthly or quarterly injections. Lifestyle advice includes keeping regular habits, particularly around sleep, meals and stress levels, as changes to a person’s environment are a common trigger.
